55-year-old female working as a registered nurse for 33 years. Lives with her husband. She has two adult children and grandchildren who live in Wisconsin.
- Past Medical History: Uncontrolled type 2 diabetes (Diagnosed 2001, A1c 14.0% in October 2024), stroke X3 with hospitalization (most recent October 2024), high blood pressure (138/92), high cholesterol, peripheral neuropathy, diabetic retinopathy (vision loss), broken shoulder and left upper arm due to a fall in the past year, back pain
- Social History: Tobacco use ¼ ppd since college- quit in 2022, high stress level
- Status at Enrollment:
- Resistant to engagement due to healthcare background
- Experiencing both highs and lows with blood glucose – not taking insulin therapy as prescribed
- Non-adherent to medication (insulin) due to dislike of needles and fear of lows
- Unfortunately, non-adherence with insulin therapy led to highly uncontrolled diabetes and resulted in her stroke in October 2024.
- Medications:
- Diabetes: Novolin R Flexpen (short-acting insulin), Insulin Glargine (long-acting insulin), Dexcom (continuous blood glucose monitoring)
- Post-Stroke Protocol: Clopidogrel, Aspirin
- High Blood Pressure: Losartan, Carvedilol, Amlodipine
- High Cholesterol: Atorvastatin
- Interventions:
- Pharmacist uncovered insulin non-adherence contributing to consistent episodes of highs and lows throughout the week
- Worked with the provider to adjust the insulin regimen reduced Novolin R from 40 units three times daily with meals to 15 units three times daily with meals and 5 units at bedtime
- Health Coach engaged and worked on stress reduction strategies, portion control with each meal, and enhanced opportunities for physical activity throughout the day.
- Pharmacist uncovered insulin non-adherence contributing to consistent episodes of highs and lows throughout the week
- Outcomes:
- Adjusting the insulin regimen led to greater tolerability and adherence and resulted in her hemoglobin A1c dropping from 14% in October 2024 to 6.9% in June 2025.
- Impact:
- Patient enrolled in the program with highly unstable type 2 diabetes that has already resulted in multiple strokes, associated hospitalizations, and long-term deficits along with other secondary complications, including vision loss and neuropathy.
- Improvement and stabilization of her blood glucose, evidenced by her most recent A1c of 6.9%, will significantly reduce risk for further catastrophic events and disease progression.